The latest updates on prescription drugs and ways to save from the GoodRx medical team

Taking Symbicort for Asthma? Here’s How to Save

by Tori Marsh on December 14, 2017 at 5:13 pm

Symbicort (budesonide/formoterol) is a common maintenance inhaler, taken on a daily basis to treat asthma and COPD, but it’s not cheap. Cash prices average around $323 for one inhaler, and out of pocket costs for those who fill Symbicort regularly can be unmanageable.

Symbicort works well. Around 60% of people rate that Symbicort is ‘worth it’, according to our friends at Iodine. If Symbicort works well for you, or your doctor thinks it’s best for you, how can you make it more affordable? Here’s some information about Symbicort and how you can save.

How Popular is Symbicort?

Symbicort is the second most popular beta agonist/corticosteroid, a class of drugs used to treat Asthma and COPD. Other common drugs in this class include Advair, Breo Ellipta, Dulera and Airduo.

When will generic Symbicort be available?

As of December 2017, there is no generic Symbicort available. In January of 2017, manufacturer AstraZeneca received an extension on their patent exclusivity, which will allow for them to continue to be the sole manufacturer until mid to late 2018.

At present, there have been few reports of manufacturers developing a generic alternative, and no applications have been approved by the FDA. But with increasing pressure from popular inhaler Advair, and AirDuo (AirDuo just got its first generic equivalent), AstraZeneca will need to keep their prices for Symbicort competitive. While this doesn’t necessarily mean we will see a generic soon, this competition could speed up the process.

Are there any cheaper alternatives?

Since few generic beta agonist/corticosteroid inhalers exist, cash prices for alternatives could be just as expensive as Symbicort. However, depending on your insurance coverage, some alternative inhalers might be more affordable.

  • Breo Ellipta is another common inhaler used to treat asthma and COPD and is used to provide long-term control of symptoms. The downside? Breo Ellipta contains an ingredient that can cause a yeast build up in your mouth and throat, and should not be taken by those who are allergic to milk.
  • Dulera is a combination inhaler used to improve lung function and can reduce the number of asthma flare-ups by 70%.
  • AirDuo (fluticasone/salmeterol) is one of the only alternative inhalers that has a generic. In fact manufacturer, Teva released brand name AirDuo and a generic fluticasone/salmeterol at the same time – the move was aimed at increasing access to lower-cost inhalers and competing in the asthma inhaler marketplace. Cash prices for generic fluticasone/salmeterol average around $89. That’s definitely more affordable than $323 for Advair. As always, be sure to speak with your doctor to see if AirDuo is right for you.

Symbicort is also often compared to GlaxoSmithKline’s popular inhaler Advair, but how interchangeable are they?

Symbicort vs Advair

Advair and Symbicort are very similar in natureand many patients wonder which is best for them. While both Symbicort and Advair are both used to treat Asthma and COPD, they have several noteworthy differences.

First off, Symbicort and Advair have different active ingredients. These active ingredients are especially important to pay attention to, especially if you are on other medications that could have a negative interaction.

Another difference? The price. Advair tends to be a little more expensive. The average cash price for Advair is $367, while Symbicort is $323.

One final note. Be sure you know that both Symbicort and Advair are not rescue inhalers – they cannot be used to treat acute symptoms like an asthma attack.

Symbicort still works best for me: How can I save?

  • Save with Symbicort’s manufacturer coupon or patient assistance program. Manufacturer AstraZeneca offers a manufacturer coupon program and patient assistance program for patients with and without insurance coverage. The Symbicort $25 Guarantee Program can reduce your payment to as little as $25 per month for one year, while the Patient Assistance Program can help you receive your medication at no cost if you qualify. For more information on eligibility and enrolling, be sure to read through our Symbicort Savings Tips.
  • Use a Symbicort coupon from GoodRx. GoodRx offers discounts for Symbicort online which can save at least 15% off the full retail price
  • Try to appeal your coverage. If you have insurance and your plan doesn’t cover Symbicort, ask your doctor about submitting an appeal, Some plans require prior authorizations—meaning you need permission from your insurance plan and a special request from your doctor before you can fill your prescription. If you have insurance, call your provider and ask how to get this process started.

GoodRx, Now Available on an Alexa Device Near You

by GoodRx on December 14, 2017 at 4:42 pm

“Alexa, tell GoodRx to help me find savings on Synthroid.”

Introducing a new way to find the cheapest prescription drugs – it’s even hands-free! We’ve built a voice-activated app so people with Alexa-enabled devices can now ask their personal assistant to look up where they can get their medications at the lowest price.

Here’s how it works: Say “Open GoodRx” to start up the app and you’ll be asked which drug you’re looking for. After confirming your dosage and formulation, Alexa will list out several nearby retail pharmacies that carry the medication, sorted by price. You can be a little more demanding by asking for a specific pharmacy, or get the GoodRx coupon texted directly to your phone. You can even set up refill reminders.

With the increasing accessibility of smart homes and smart devices, voice interaction was the next logical step, as we’re not always around a screen 24/7. GoodRx users come to our site with one main goal in mind – and now they can do it by just talking. We hope the ease of the Alexa app can help busy patients at home, and also doctors so they can instantly find prices with patients in the office.

Want to try it out yourself? Here are some example commands to activate the app:

  • “Alexa, ask GoodRx what is the cheapest price for (drug name)”
  • “Alexa, tell GoodRx I need prices for (drug name) at (pharmacy name)”
  • “Alexa, ask GoodRx what’s the cheapest price for (drug name) (dosage)

Riomet for Diabetes Recalled Due to Contamination

by The GoodRx Pharmacist on December 14, 2017 at 3:56 pm

Believe it or not, medications are recalled on a daily basis for numerous reasons. Recalls can range from minor to life-threatening incidents if not immediately and appropriately taken care of.

One of the most recent recalls, occurring on November 24th, involves Riomet, the first and only liquid formation of metformin for diabetes.   

What is Riomet indicated for?

Riomet is indicated (in addition to diet and exercise) to improve blood sugar control in adults and children 10 years of age and older with type 2 diabetes.

Why was Riomet recalled?

Riomet has been found to be contaminated with a type of fungus known as Scopulariopsis brevicaulis. If injected, this fungus can cause an increased risk of infection, especially in those who are immunocompromised.

Have there been any adverse event reports to Sun Pharmaceutical Industries from patients?

No.  At this time, Sun Pharmaceuticals has not received any reports of adverse events associated with this recall.

Which Riomet products were recalled?

According to the FDA’s Announcement, the affected products were distributed nationwide to wholesale customers in the United States.  

This recall will affect the following:

  • Drug: Riomet 500 mg/5 ml
  • Manufacturer: Sun Pharmaceuticals Industries (but the recalled product was actually being made by a contract manufacturer)
  • Bottle size: 118 ml (4 ounce) bottle, and 473 ml (16 ounce) bottle
  • National Drug Codes: 10631-206-01 (lot A160031) and 10631-206-02 (A160031B)

What has been done to alert those who may be affected?

On April 18, 2017, Sun Pharmaceutical Industries notified its wholesale customers through its 3rd party recall coordinator (Inmar Inc.) and has arranged for the return via prepaid FedEx Ground shipping of all recalled products.

What do I do if I think I have a recalled package?

Consumers who have purchased this product should not open the package or use the contents. Instead, they should return the product to the location of purchase for a full refund, or call Sun Pharmaceuticals at 1-800-406-7984. You should contact your physician or healthcare provider if you have experienced any problems that may be related to taking or using these drug products.

Always inspect your medications, including all parts of the packaging and devices. If you ever notice your medication doesn’t look or smell right, contact the manufacturer or ask your pharmacist for more information. You can also notify the FDA’s MedWatch Reporting Program as they can conduct further necessary investigations.


Are You Taking Too Much Tylenol Without Knowing It?

by Katie Mui on December 13, 2017 at 3:58 pm

Pretty much everyone experiences pain at some point in their lives. Sometimes it’s just a headache or a minor injury or brief illness — but for many, pain involves more chronic issues such as arthritis or back pain.

Many medications can help manage pain, with the best known being over the counter pain relievers like Motrin (ibuprofen), Aleve (naproxen), or Tylenol (acetaminophen). These drugs (except Tylenol) — known as NSAIDs, short for nonsteroidal anti-inflammatory drugs — work remarkably well for a variety of conditions.

So whats the problem? They work so well that these products get tossed into many other medications, both over-the-counter or prescription-only formulations. That makes it surprisingly easy to take too much without even knowing it. Here’s a quick guide to pain relievers by our friends at Iodine.

The Problem

Tylenol (acetaminophen) is a common pain relief agent in the U.S. and can also be used to help reduce fevers. As such, it is often combined in multiple products for a cough and cold and not just pain products.

Unintentionally taking too much Tylenol/acetaminophen happens far more often than you think because the average person doesn’t know what the drugs they’re taking have in them. It’s an all too common mistake, as seen in this sample case, where someone may be taking Tylenol Extra Strength for pain, but now with a cold is also taking Dayquil:

The Cause

Acetaminophen is broken down via the liver. Overall, when taking the recommended doses on the bottle, the liver does its job just fine for the majority of the population. The issue is when taking too much of acetaminophen, you can overload the liver, leading to liver failure and possibly death.

The other issue is mixing acetaminophen with alcohol. Because alcohol is broken down by the liver as well, these two will interact and overtax the liver in a short period of time. Acetaminophen will also build up in the liver which can lead to problems even if you didn’t take that much at once.

What can you do?

It’s wise to always check if the medication you’re taking or giving to someone has acetaminophen in it. Generally, if it’s used for pain, cough, cold, or allergies, there’s a good chance it contains acetaminophen.

The FDA suggests 4000 mg (or 4 grams) of acetaminophen is the maximum safe amount to ingest in a 24 hour period. Acetaminophen is often seen in common combination doses of 500 mg or 325 mg. For example, in Dayquil, each dose has 325mg of acetaminophen. Percocet and Vicodin are also combination pain drugs, with each having 5 mg of opioids and 325mg of acetaminophen.   

And alcohol and acetaminophen? The FDA warns against combining acetaminophen with 3 or more alcoholic drinks a day. So if you are out drinking heavily and reaching for Tylenol before you go to bed to keep that headache away in the morning, don’t do it!

Takeaways 

  • Tylenol/acetaminophen is a relatively safe medication used often to treat pain or fever. It’s found in many products over-the-counter and in combination with other prescribed agents for pain, cough, cold, and allergy.
  • The FDA has set standards on how much Tylenol/acetaminophen should be taken based on risks of overdose that could lead to complications and possible death.
  • Always check how much Tylenol/acetaminophen you are taking, both on its own or in a combination medication, especially if you already take it chronically for a condition.

Thanks to pharmacist Timothy Aungst and Iodine.com for help with this post.


10 Times Your Doctor Was Wrong About a Medication

by Dr. Sharon Orrange on December 12, 2017 at 2:42 pm

I know what you’re thinking…your doctor has probably been wrong more than ten times. I agree, but there have been times when the standard of care across the country has changed on a dime, and physicians went from routinely prescribing a medication to learning it may not be helpful at all.

Here are ten notable “whoops” times.      

  1. Hormone replacement therapy (HRT). For years, physicians were initiating HRT in postmenopausal women praising its protection against stroke and heart disease. Well, the data showed otherwise. Hormone replacement therapy is the best treatment for relief of hot flashes and night sweats, vaginal dryness, and may protect against bone loss early in menopause. The problem? Combined hormone therapy is also linked to a small increased risk of heart attack. Some research suggests that women who start combined therapy within 10 years of menopause and who are younger than 60 years, may get some protection, but HRT should not be used solely to protect against heart disease.   
  2. Digoxin (Digitek or Lanoxin). The warnings here keep getting stronger, and this year we learned that in patients with atrial fibrillation without heart failure, Digoxin was significantly associated with sudden cardiac death. The association between Digoxin use and poor clinical outcomes highlights the need to examine its use, particularly when prescribed to control heart rate in patients with atrial fibrillation. There are newer safer options.
  3. Bisphosphonates. This class includes medications like alendronate (Fosamax) and ibandronate (Boniva), which are indicated for the treatment of osteoporosis. When they were first approved, physicians prescribed these medications to women who had early signs of bone loss or bone thinning to prevent osteoporosis. The problem? Bisphosphonates inhibit bone remodeling and reduce the bone repair process which can lead to fractures. While they are still used for the treatment of osteoporosis and help prevent hip and spine fractures, they are not indicated for those with just mild thinning or mild bone loss.
  4. NSAIDS. Naproxen, Motrin, and Advil were believed to be relatively safe and effective even when used long term. Now we know that anyone who is at risk for or who has cardiovascular disease (coronary artery disease) may have a further increase in the risk of heart attacks when taking an NSAID. Let me be clear though, short-term intermittent use is fine.
  5. Proton pump inhibitors (PPI). The long-term use of proton pump inhibitors is also gathering more worrisome data. Turns out, you should try not to take proton pump inhibitors long-term. Medications in this class include omeprazole, esomeprazole, and pantoprazole. While they work well for reflux, esophagitis, gastritis and ulcer disease, it now appears that PPI use can lead to a higher risk of stomach cancer. Additionally, long-term use can also lead to vitamin B12 deficiency, increased risk of c-diff diarrhea, and some bone loss.
  6. Steroids. Physicians used to prescribe oral steroids for everything from poison oak, itchy rashes, allergies and ear congestion. A Medrol dose pack or prednisone for less severe illnesses is not recommended. Studies suggest that even short courses of oral steroids are associated with adverse effects that should be considered before prescribing 
  7. NiacinTricor and gemfibrozilUp until last year, physicians were prescribing these in combination with the cholesterol-lowering meds “statins.” However this combination showed little benefit, and the two are not recommended by the FDA for co-administration. This move also affected Niacin, fenofibric acidAdvicor, and SimcorThe FDA determined that the benefits of these medications along with statins no longer outweigh the risks.
  8. Avastin (bevacizumab). This was another medication that had its FDA approval yanked. Used for metastatic breast cancer, FDA approval was revoked when it was not shown to provide a benefit in terms of delay in the growth of tumors. Nor is there evidence that use of Avastin helped women with breast cancer live longer or improve their quality of life. Depressing.
  9. Epogen (epoetin alpha). This injection is given to stimulate red cells. Up until 2011, we were using it for the treatment of anemia (low red blood cell count) in people with kidney disease. That was until a study showed that the use of Epogen in these patients was associated with a 30% increased risk of acute stroke. Ugh.
  10. Diet meds. There has not been a great track record for weight loss medications. Fen Phen many of you remember was pulled from the market in 1997 after contributing to pulmonary hypertension and heart valve disease. Much later came Meridia (Sibutramine) for weight loss which was pulled in 2010 due to increased risk of stroke and heart disease. So, there’s that.

Dr O.


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